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September 5, 2012

CPR Saves More Lives When Administered Just A Few Minutes Longer

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Lawrence LeBlond for redOrbit.com - Your Universe Online

It is well-known that cardiopulmonary resuscitation (CPR) saves lives. But knowing how long to continue the practice after a victim has stopped breathing may be key in the survival of the patient. New evidence suggests that continuing the emergency procedure for a short time longer than what most medical professionals attempt can significantly boost the odds of survival in some patients, according to a study published in The Lancet medical journal on Wednesday.

The researchers involved in the latest study found that patients at hospitals with longer resuscitation efforts, on average, had longer survival rates. The study was led by Zachary Goldberger at the University of Washington and included colleagues from the University of Michigan Health System. Goldberger and his team looked at a database where US hospitals record details of revival efforts after cardiac arrest.

The US hospital registry covered 64,000 patients from 435 US hospitals between 2000 and 2008. The team found that hospitals spent, on average, 20 minutes attempting CPR before pronouncing victims dead. But for hospitals that attempted CPR, on average, 25 minutes, showed a 12 percent higher chance of patient response than those whose efforts were shortest (average 16 minutes)

While there is no standard for how long doctors should, and must, perform CPR, the new research shows a strong indication that longer attempts would in fact save more lives. In developed countries, less than 20 percent of all patients who suffer cardiac arrest survive. And in some of these instances, longer CPR attempts may have been the key to a better chance of survival. However, the team also notes that most cardiac arrest patients are successfully resuscitated after a short timeframe--generally within 12 minutes on average. And most practitioners are reluctant to perform longer attempts, especially those lasting longer than 30 minutes, due to relatively poor prognosis.

The research team, however, found that successful CPR only occurred after 30 minutes or more in some patients. And the team also found, more importantly, that those who survived with longer arrest times did not appear to have substantially worse neurological function at discharge

Goldberger said he is not surprised that there exists a wide variation in hospitals´ average length of resuscitation attempts, given there is no set guidelines for practitioners to follow on when to stop efforts to successfully resuscitate cardiac arrest patients.

“Our findings suggest an opportunity for improving care in this high-risk population. Overall, it may involve standardizing the time required for continuing resuscitation attempts prior to decisions regarding termination of efforts,” Goldberger said.

Brahmajee K. Nallamothu, M.D., M.P.H. and senior author of the study from U-M, said that while the study implies that longer resuscitation attempts should be considered by medical professionals, the research does not outline how long CPR should be given.

“We want to emphasize that our findings cannot identify an optimal duration for which to resuscitate patients,” he explained.

“The optimal resuscitation duration for any individual patient will continue to remain a bedside decision that relies on careful clinical judgment,” added Study coauthor Steven L. Kronick, M.D., M.S., a U-M emergency department physician and head of the university´s CPR committee.. “Overall, we believe these findings present an opportunity to improve resuscitation care, especially at a systems-level.”

Funding for this study was provided by the American Heart Association (AHA). A final manuscript draft of the study was also approved by the AHA´s Scientific Committee.